Pleura: Anatomy, Physiology, and Disorders

Disorders of the pleura and pleural space reflect some of the oldest diseases encountered in surgical history. Hippocrates described the symptoms of empyema 2400 years ago: “Empyema may be recognized by the following symptoms: In the first place the fever is constant, less during the day and greater at night, and copious sweats supervene. There is a desire to cough and the patient expectorates nothing worth mentioning.” He also described an open drainage procedure: “When the fifteenth day after rupture has appeared, prepare a warm bath, set him upon a stool, which is not wobbly, someone should hold his hands, then shake him by the shoulders and listen to see on which side a noise is heard. And right at this place, preferably on the left, make an incision, then it produces death more rarely.”1,2 Beyond providing less-wobbly stools, few advances were made for more than 2000 years that allowed surgeons to routinely enter the pleural cavity, the fear being a potentially fatal pneumothorax. With the advent of positive pressure ventilation in the early 1900s, pneumothorax was no longer a prohibitive risk, and the era of surgical intervention in the pleural cavity had begun.3